System and Method for Monitoring Clinician Responsiveness to Alarms

ABSTRACT

A method of monitoring clinician responsiveness to alarms generated by patient monitors. The method includes the steps of: receiving an alarm event from a patient monitor at a central monitor, determining an alarm initiation time for the alarm events, receiving at the central monitor an acknowledgement of the alarm event by a clinician, calculating an event response time as the time between the alarm initiation time and the acknowledgement of the alarm event by the clinician, determining a total number of alarm events, determining event response times for each of the total number of alarm events, and computing a responsiveness score based on the event response time for each of the total number of alarm events.

BACKGROUND

Patient monitoring devices, such as devices monitoring a patient's vitalsigns, are designed to identify physiological problems experienced bypatients and to alert clinicians to those problems. Typically,clinicians are alerted to such problems via the generation of alarms,such as auditory or visual alarms, or alerts sent directly to pagers orpersonal digital assistants (PDAs) carried by clinicians. Alarms mayalso be generated by patient monitors when problems occur with themonitor itself, such as a low battery, disconnection of patientmonitoring lead, etc.

Hazards may arise when alarms go unrecognized or are not acted upon fora period of time. Clinicians responsible for monitoring patient alarmsmay receive frequent visual and audio alarm notifications for thosealarms. Such repetitive exposure to alarm notifications can cause aclinician to become de-sensitized to the alarms, which affects thetimeliness of his or her responses. Additionally, clinicians may beginto ignore alarms as a result of the frequent occurrence of false alarmevents, which may cause the clinician to believe the alarms areunimportant and do not need a response.

Alternatively, a clinician may desire to attend to all alarm events, butmay be unable to respond to alarm events in a timely manner because theclinician's work flow is too heavy. Several alarms may occur at once,and/or a hospital floor may be understaffed, which may create a scenarioin which it is impossible for a clinician to respond to all alarm eventsin a timely manner.

Unheeded alarms negatively affect patient care, and can lead toundesired outcomes for patients. An alarm event may indicate adeterioration of a patient's physiological condition, which oftenrequires immediate attention. Alternatively, technical alarms may occurthat indicate the inability of a patient monitor to accurately monitor apatient's condition.

Thus, methods and systems are needed for monitoring and measuringclinicians' responses to alarms.

SUMMARY

The present disclosure stems from the inventor's research anddevelopment of methods and systems for monitoring and analyzingclinicians' responsiveness to alarm events. The present inventor hasrecognized that prior art monitoring systems do not provide a way forhospitals or medical facilities to monitor how and when clinicians areresponding to alarms generated by patient monitors. The present inventorfurther recognized that methods and systems are needed for determiningwhen and to what extent clinicians are experiencing alarm fatigue, andfor analyzing trends in clinician responsiveness to alarms. The inventoralso recognized that such systems and methods would allow hospitals andmedical facilities to maintain a high level of medical care byestablishing a system which encourages clinicians to respond to alarmevents in a timely manner and allows monitoring of such responses.Further, such a system allows a facility to optimize its workflow andidentify and alleviate problems which may arise involving alarm fatigue,

One embodiment relates to a method of monitoring clinicianresponsiveness to alarms generated by patient monitors comprising thefollowing steps: receiving an alarm event from a patient monitor at acentral monitor, determining an alarm initiation time for the alarmevent, receiving at the central monitor an acknowledgement of the alarmevent by a clinician, calculating an event response time as the timebetween the alarm initiation time and the acknowledgement of the alarmevent by the clinician, determining a total number of alarm events,determining event response times for each of the total number of alarmevents, and computing a responsiveness score based on the event responsetime for each of the total number of alarm events. The method of claim 1may further include the step of determining an allowable response periodfor the alarm event received at the central monitor, and computing theresponsiveness score based further on a comparison between the eventresponse time and the allowable response period. Various rules areentered into the system to determine when alerts are generated toadministrators based on either one or a series of responsiveness scoresfor the clinician. If the responsiveness score or scores indicate thatone or more clinicians are not being sufficiently responsive to alarms,alerts may be generated to notify an administrator of the insufficientresponsiveness. Additionally, reports may be generated to summarizeresponsiveness scores and/or indicate trends in responsiveness scores.

Another embodiment relates to a method of monitoring clinicianresponsiveness to alarms including the following steps: receiving at acentral monitor a notification of an alarm event from a patient monitorwherein the notification includes an alarm initiation time and an alarmtype, determining an allowable response period for the alarm event basedon the alarm type, receiving at the central monitor an acknowledgementof the alarm event by a clinician, calculating an event response time asthe time between the alarm initiation time and the acknowledgement ofthe alarm event, and computing a responsiveness score based on the eventresponse time and the allowable response period. The method may furtherinclude the step of determining a total number of alarm events, and theresponsiveness score may be further based on the total number of alarmevents. For example, the responsiveness score may be equal to apercentage of the total alarm events wherein the response time is lessthan the allowable response period.

Yet another embodiment relates to a system for monitoring clinicianresponsiveness to alarms. The system comprises a patient monitor, acentral monitor, and a control unit. The patient monitor is configuredto receive physiological patient data, detect the occurrence of an alarmcondition, and transmit notification of that alarm condition. Thecentral monitor is configured to receive the notification of the alarmcondition from the patient monitor, and to also receive anacknowledgement of the alarm condition by a clinician. The control unitis configured to receive the notification of the alarm condition and theacknowledgement of the alarm condition from the central monitor,calculate an event response time as the time it took the clinician toacknowledge the alarm condition, determine a total number of alarmevents, compute a responsiveness score based on the event response timefor each of the total number of alarm events, and store theresponsiveness score on a computer readable memory device.

Other principles, features and advantages of the invention will becomeapparent to those skilled in the art upon review of the followingdrawings, the detailed description, and the appended claims.

BRIEF DESCRIPTION OF THE DRAWINGS

The drawings illustrate the best mode presently contemplated of carryingout the disclosure. In the drawings:

FIG. 1 is a schematic of an embodiment of a system and method formonitoring clinician responsiveness to alarms.

FIG. 2 is a schematic of another embodiment of a system and method formonitoring clinician responsiveness to alarms.

FIG. 3 is a flowchart of the steps performed in an exemplary method ofmonitoring clinician responsiveness to alarms.

DETAILED DESCRIPTION OF THE DRAWINGS

In the present description, certain terms have been used for brevity,clarity and understanding. No unnecessary limitations are to be impliedtherefrom beyond the requirement of the prior art because such terms areused for descriptive purposes only and are intended to be broadlyconstrued. The different systems and methods described herein may beused alone or in combination with other systems and methods. Variousequivalents, alternatives, and modifications are possible within thescope of the appended claims. Each limitation in the appended claims isintended to evoke interpretation under 35 USC §112, sixth paragraph,only if the terms “means for” or “step for” are explicitly recited inthe respective limitation.

Referring to FIG. 1, a monitoring system 80 may include a centralmonitor 10 configured to receive alarm events 8 generated by one or morepatient monitors 6 connected to one or more patients 2. The centralmonitor 10 may also be configured to receive alarm acknowledgements 12by clinicians 4. The monitoring system 80 may have an analysis unit 82which processes alarm event data and alarm acknowledgement data acquiredby the central monitor and produces an output. The output from theanalysis unit 82 may be in form of scores, reports, trends, or any otherformat known in the art as appropriate for conveying such statistical orqualitative information.

The analysis unit 82 has a control unit 91 that orchestrates the alarmanalysis process. The analysis unit 82 receives data input from thecentral monitor 10, including information regarding alarm events 8and/or alarm acknowledgements 12. The analysis unit 82 processes datareceived from the central monitor 10 according to rules established bythe programmable rules engine 92. As depicted in FIG. 2 and explainedfurther below, the programmable rules engine 93 may contain a set ofrules 28 for processing 24 alarm events 8 and response times 20.

Referring to both FIGS. 1 and 2, the analysis unit 82 may detect thepresence of hazardous situations, such as a clinician 4 experiencingalarm fatigue or an alarm event that has not been acknowledged after along period of time, In response to the detection of such a hazard, theanalysis unit 82 may generate an alert 36 to inform the appropriateparty of the hazard. For example in FIG. 1, upon detection of an alarmevent that has not been acknowledged, the analysis unit 82 may generatean escalated alarm alert 86 to alert a nurse administrator 38 to themissed alarm. As another example, the analysis unit 82 may generate analarm fatigue alert 89 to the administrator 38 if it detects thepossibility of a clinician 4 who may be experiencing alarm fatigue. Thepurpose of the alarm fatigue alert is to alert an administrator 38 whena clinician has become de-sensitized to alarms due to suffering frequentalarm notifications for a period of time such that the clinicians'responsiveness to alarms is lagging. The alarm fatigue alert may begenerated to alert a nurse administrator 38 if a responsiveness score 30falls below a threshold level. Alternatively, an alarm fatigue alert maybe generated if the responsiveness score 30 trends downward at aspecified rate.

The output produced by the analysis unit may be received by a display84. The display 84 may be configured to display any informationtransmitted by the analysis unit 82, including responsiveness scores 30,alerts 36, or reports 34. The display 84 may be a central displayscreen, for example at a nurses' station. Alternatively, the display 84could be any number of personal displays, including personal computerdisplays, hand held displays, pagers, or the like. The purpose of thedisplay 84 is to transmit information from the analysis unit 82 to anappropriate nurse administrator or clinician. The central monitor 10 andthe analysis unit 82 may be integrated into one device that iscontrolled by a single control unit, or they may be two separate deviceswith two separate control units. Likewise, the display unit may beintegrated with either the central monitor 10 and/or the analysis unit82.

FIG. 2 depicts another embodiment of a system and method for monitoringclinician responsiveness to alarms. The patient monitor 6 collectsphysiological data from a patient 2 and generates an alarm event 8 upondetection of an alarm condition. The patient monitor 6 may also generatean alarm event 8 if it encounters a technical problem that needs to beremedied by a clinician or other staff member. The alarm events 8 aredetected by a central monitor 10. The central monitor 10 may also detectspecifics regarding the alarm event, such as the type of alarmgenerated, the reason for the alarm generation, the time that the alarmwas initiated, the severity of the alarm, etc.

The central monitor 10 may also detect when an alarm is acknowledged bya clinician 4. Alarm acknowledgements 12 may be made by a clinician 4 inany way known in the art. For example, clinicians 4 may acknowledgealarms at the patient monitor 6 where the alarm occurred. The alarmacknowledgement 12 may include remedying the condition which generatedthe alarm event 8. The patient monitor 6 could then detect that thealarm condition has been remedied and could terminate the alarm event 8.For example, in the instance of a technical alarm, such as a low batteryin a patient monitor 6, the clinician 4 may remedy the technical alarmby replacing the battery in the patient monitor 6. The patient monitor 6would then terminate the alarm event 8 generated in response to the lowbattery alarm. The central monitor 10 may recognize the termination ofthe alarm event as an alarm acknowledgement 12 by the clinician 4.Alternatively, a clinician 4 may acknowledge 12 an alarm event 8 byclicking on an acknowledgement button on a display screen of the patientmonitor 6, or on a display screen at a central monitoring station.

The central monitor 10 relays the alarm event information and/or thealarm acknowledgement information to the analysis unit 82. The analysisunit 82 analyzes the alarm event information and alarm acknowledgementinformation and produces information summaries and reports regardingclinician responsiveness to alarm events. The analysis unit 82 maycalculate a response time 20 for a particular alarm event 8, such as bycalculating the time between the initiation of the alarm event 8 and thealarm acknowledgement 12 by the clinician 4.

The analysis unit 82 may also calculate an alarm event total 22. Thetotal alarm events 22 may represent a summation of all the alarm eventsoccurring in a particular area of the medical facility in a particularperiod of time. Alternatively, the total alarm events may represent thetotal number of a certain type of alarm event, such as a critical alarmevent. In still other embodiments, the total alarm events 22 mayrepresent a summation of the alarm events generated by a particularpatient monitor 6 within a certain period of time. In still otherembodiments, the total alarm events 22 may represent a summation of thealarms acknowledged by a particular clinician 4 or a group of cliniciansover a specified period of time.

The analysis unit 82 may process 24 the total number of alarm events 22and the response time 20 for each of the events therein. The analysisunit 82 may process the data according to rules 28 generated by theprogrammable rules engine 93. The programmable rules engine 93 can beconfigured as shown by arrow 27, such as by a system administrator 26.The programmable rules engine 93 may contain a set of rules forprocessing 24 alarm events and response times. For example, the rules 28of the programmable rules engine 93 may dictate how alarm events are tobe processed or weighted based on the type of alarm which initiated thealarm event 8—e.g., responsiveness data regarding critical alarms isweighted more heavily than that regarding non-critical alarms. Otherrules 28 may dictate the determination of an allowable response periodfor each alarm event. The allowable response period set by a rule 28 maybe a maximum amount of time in which a clinician should acknowledge orrespond to an alarm event. The rule 28 may dictate the calculation ofthe allowable response period based on information about the alarm eventgathered by the central monitor, such as the type of alarm or theseverity of the alarm. Other rules 28 set out in the programmable rulesengine 93 regard the processing of alarm information based on the numberof pending, unacknowledged alarm events, the number of alarm eventsoccurring simultaneously or at overlapping times, the number ofclinicians available to attend to alarms, and/or the alarmacknowledgement history of the attending clinicians.

The analysis unit 82 processes 24 the total alarm events 22, theresponse time 20, and other alarm-related information to produce aresponsiveness score 30. The responsiveness score 30 may represent theresponsiveness of a clinician 4 to the total number of alarm events 22.Alternatively, the responsiveness score 30 may represent theresponsiveness of a group of clinicians, or the responsiveness of allclinicians in a medical facility, or a portion thereof. In still otherembodiments, the responsiveness score 30 may be based on responses to arepresentative set of alarm events, or to the alarm events occurringover a particular period of time, or a particular portion of clinicians'shifts. In still other embodiments, the responsiveness score 30 mayrepresent the responsiveness of one or more clinicians to a particulartype of alarm event 8, such as a critical alarm, a cardiac alarm, ablood pressure alarm, a respiratory alarm, a technical alarm, etc.

The responsiveness score 30 may be calculated according to variousdifferent scoring systems depending upon user requirements. For example,the responsiveness score could be calculated based upon the total alarmevents 22 and their response times 20 e.g., based on a simple average ofthe alarm response times. Alternatively, the score could reflect ratedanalysis dictated by the programmable rules engine 93, such as rulesweighting the severity of each alarm, the demand placed on the clinicianduring the response period due to the occurrence of simultaneous oroverlapping alarm events, a clinicians' response history, etc.Additionally, the responsiveness score may account for the comparison ofthe response times to the allowable response period. For example, theresponse score may be a percentage of the total alarm events 22 in whichthe response times 20 were less than or equal to the allowable responseperiod.

The responsiveness score 30 could be expressed according to any scale orsystem. For example, the responsiveness score 30 could be expressed on a1 to 10 scale, or on a traditional A to F grading scale. In otherembodiments, the responsiveness score 30 could be more nuanced andconvey more detailed information. For example, the score could havemultiple parts or sections, each conveying information about qualityand/or quality of a clinician's responsiveness to different types ofalarm events or alarm events occurring at different times during ashift. In still other embodiments, the responsiveness score could be asliding scale with one end representing perfect responsiveness wherein aclinician responded to all alarms in a minimum amount of time and theother end representing poor responsiveness wherein a clinician fails toacknowledge any alarm events within the allowable response period. Sucha sliding scale could account for any number of rules 28, and thus couldrepresent a varying level of complexity based on the configuration ofthe programmable rules engine 93.

Upon calculating a responsiveness score 30, the analysis unit 82 maycommunicate the responsiveness score to a nurse administrator 38 orother administrator through a display or some other communicationdevice. Alternatively or additionally, the analysis unit 82 may producealerts 36 or reports 34.

Alerts 36 may be generated by the analysis unit 82 if the responsivenessscore reflects poor responsiveness to alarm events 8. Such alerts 36 mayinclude escalated alarm alerts, alarm fatigue alerts, or alerts as totrends in responsiveness score, such as trends representing a decreasein clinician responsiveness. Such alerts may be transmitted to a nurseadministrator 38, or another appropriate individual, via any means knownin the art for transmitting an alarm notice. For example, the alert maybe transmitted through an auditory alarm, a visual alarm, a notificationon a display, or through a personal device, such as a pager or a PDA.

Other alerts 36 may also be generated by the analysis unit 82. Forexample, an alert 36 may be generated to alert an administrator if alarge number of alarm events 8 are pending simultaneously. Such an alertwould help the administrator allocate staffing and other resourcesappropriately so that all alarm events could be attended to in a timelymanner. Conversely, the analysis unit 82 could generate an alert 36 upondetecting an abundance of clinicians in an area where no alarm eventsare occurring. Again, that alert could allow an administrator tooptimize staffing and resources.

The analysis unit 82 may also assess 32 the responsiveness score 30 togenerate reports 34. The reports 34 could convey any information aboutalarm events or clinician responses thereto. For example, the reports 34could convey trends in clinician responsiveness to alarms according totime of day, shift duration, staffing members, alarm type, frequency ofalarms, etc. The reports 34 may identify periods where clinicianresponsiveness to alarms was relatively poor and may identify reasonsfor such poor responsiveness. For example, the reports 34 may identifyperiods of time where the number of alarm events was relatively highand/or the number of available clinicians was relatively low.Additionally, the reports 34 may identify periods where cliniciansexperience alarm fatigue.

Referring to FIG. 3, the flowchart depicts one embodiment of a method ofmonitoring clinician responsiveness to alarms. Initially, an alarm eventis received 50, for example at a central monitor. The alarm event datareceived may include details regarding the alarm event, including thetype of alarm that generated the event, the criticality or severity ofthe condition that generated the alarm, and/or the initiation time ofthe alarm. Upon receiving the alarm event at block 50, the control unitmay determine the allowable response period, block 52, for theparticular alarm event. The determination of the allowable responseperiod may be based on the type or severity of the alarm event receivedat block 50.

Following its determination of the allowable response period 52, thecontrol unit transitions to block 55 wherein it determines whether thealarm condition has been acknowledged by a clinician. If the alarmcondition has not been acknowledged, the control unit determines whetheror not the allowable response period has been exceeded, block 57. If theallowable response period has not been exceeded, the control unit cyclesback to block 55, where it checks again to see if the alarm event hasbeen acknowledged by a clinician. At block 57, if the allowable responseperiod has been exceeded, the control unit may generate an escalatedalarm alert, block 58, to alert an administrator to the fact that thealarm event has not been acknowledged within the allowable responseperiod. The control unit then cycles back to block 55 where it checksagain to see if the alarm event has been acknowledged.

Once the alarm event is acknowledged by a clinician at block 55, thecontrol unit calculates the response time at block 60. The response timemay be calculated as the period between the alarm initiation time andthe time that the alarm is acknowledged. Alternatively, the responsetime may be calculated as the period between the time that the alarmevent was received at block 50 and the time that the alarm wasacknowledged at block 55. Next, at block 62, the control unit comparesthe response time calculated at block 60 to the allowable responseperiod calculated at block 52. The control unit then calculates thetotal alarm events at block 64 and transitions to block 66, where itcalculates a responsiveness score based on the determinations made atblocks 62 and 64.

At block 69, if the responsiveness score is below a threshold, thecontrol unit may generate an alert, block 70, such as an alarm fatiguealert. The threshold for judging the responsiveness score may be aparticular score below which a responsiveness score may be determined tobe unacceptable. Alternatively, the threshold may be a trend in a seriesof responsiveness scores, which has been determined to be the cutoffbetween an acceptable responsiveness trend and an unacceptableresponsiveness trend.

If the responsiveness score is above the threshold, as determined by thecontrol unit at block 69, the control unit may proceed to generate aresponsiveness report at block 72. Either way, whether or not theresponsiveness score is above or below the threshold, the control unitwill eventually proceed to block 72 where it generates one or moreresponsiveness reports, block 72, before terminating its process atblock 74.

This written description uses examples to disclose the invention,including the best mode, and also to enable any person skilled in theart to make and use the invention. The patentable scope of the inventionis defined by the claims, and may include other examples that occur tothose skilled in the art. Such other examples are intended to be withinthe scope of the claims if they have structural elements and/or methodsteps that do not differ from the literal language of the claims, or ifthey include equivalent structural elements and/or method steps withinsubstantial differences from the literal languages of the claims.

1-20. (canceled)
 21. A method of monitoring clinician desensitization toalarms generated by patient monitors, the method comprising: receiving aplurality of alarm events from one or more patient monitors at a centralmonitor; determining an alarm initiation time for each of the alarmevents; receiving at the central monitor an acknowledgement from theclinician of each of the alarm events; calculating an event responsetime for each of the plurality of alarm events as the time between thealarm initiation time and the acknowledgement of the alarm event by theclinician; computing a responsiveness score based on the plurality ofevent response times for the plurality of alarm events, wherein theresponsiveness score is indicative of a level of alarm fatigueexperienced by the clinician over the plurality of alarm events; andgenerating an alarm fatigue alert when the responsiveness score dropsbelow a. threshold value.
 22. The method of claim 21, further includingthe step of determining an allowable response period for each of thealarm events received at the central monitor.
 23. The method of claim22, wherein the allowable response period is determined based on thetype of alarm event received form the patient monitor, wherein theallowable response period is shorter for more critical types of alarmevents.
 24. The method of claim 22, wherein the allowable responseperiod is determined based on severity of the alarm event, wherein theallowable response period is shorter for more severe alarms.
 25. Themethod of claim 22, further including the step of transmitting anescalated alarm alert if the alarm event has not been acknowledgedwithin the allowable response period.
 26. The method of claim 22,wherein the responsiveness score is further computed based on acomparison between the event response time and the allowable responseperiod.
 27. The method of claim 26, wherein the responsiveness score isequal to a percentage of the total alarm events wherein the responsetime is less than the allowable response period.
 28. The method of claim21, further including the step of generating an alarm responsivenessreport.
 29. The method of claim 28, wherein the responsiveness reportincludes a trend analysis conveying changes in response score withrespect to the clinician's shift duration.
 30. The method of claim 28,wherein the responsiveness report includes a trend analysis conveyingchanges in response score with respect to a number of alarm eventspending simultaneously.
 31. The method of claim 21, wherein the alarminitiation time is the time that the alarm event was initiated at thepatient monitor.
 32. The method of claim 21, wherein the alarminitiation time is the time that the alarm event was received at thecentral monitor.
 33. A method of monitoring clinician desensitization toalarms generated by patient monitors, the method comprising: receivingat a central monitor a notification of an alarm event from a patientmonitor, wherein the notification includes an alarm initiation time andan alarm type; determining an allowable response period for the alarmevent based on the alarm type; receiving at the central monitor anacknowledgement of the alarm event by a clinician; calculating an eventresponse time for each alarm event as the time between the alarminitiation time and the acknowledgement of the alarm event; computing aresponsiveness score for the clinician over a plurality of alarm eventsbased on the event response time and the allowable response period, foreach of the plurality of alarm events, wherein the responsiveness scoreis indicative of a level of alarm fatigue experienced by the clinicianover the plurality of alarm events; and generating an alarm fatiguealert when the responsiveness drops below a threshold value.
 34. Themethod of claim 33, wherein the responsiveness score is equal to apercentage of the total alarm events wherein the response time is lessthan the allowable response period.
 35. The method of claim 33, furtherincluding the step of generating a responsiveness report, wherein theresponsiveness report conveys trends in the response times to the alarmevents.
 36. A system for monitoring clinician desensitization to alarms,comprising: a patient monitor configured to receive physiologicalpatient data, to detect an occurrence of an alarm condition, and totransmit notification of the alarm condition; a central monitorconfigured to receive the notification of the alarm condition from thepatient monitor and to receive an acknowledgement of the alarm conditionby a clinician; and a control unit configured to receive thenotification of the alarm condition and the acknowledgment of the alarmcondition from the central monitor, calculate an event response time asthe time it took the clinician to acknowledge the alarm condition,determine a total number of alarm events, compute a responsiveness scorebased on the event response time for each of the total number of alarmevents, wherein the responsiveness score is indicative of a level ofalarm fatigue experienced by the clinician over the plurality of alarmevents; generate an alarm fatigue alert when the responsiveness scoredrops below a threshold value; and store the responsiveness score on acomputer-readable memory device.